Out On The Couch - Home Archives - The Affirmative Couch

Out On The Couch

4 Barriers to Affirmative Clinic Change

Posted: 6-9-21 | Melissa Dellens

Gerald Caplan is seminal in developing some of the early theories of consulting work (Caplan, 1960). Caplan worked in Israel after World War II providing mental health support to 16,000 displaced and orphaned teens in overwhelmed residential and refugee facilities (Mendoza, 1993). Caplan’s resources were limited, and his team had no way of serving the [...]

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Black Gay Men and Crystal Meth: My Story

Posted: 5-25-21 | Jerry St. Louis, LGSW

I am Black, gay, and a social worker. I work in a recovery center where I help individuals attain and maintain their sobriety.  I have had experience on both sides of the “social service” table, and my personal and professional experience has given me access to the elusive community of crystal meth users.

A friend [...]

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Clinician Resources for Internalized Transphobia

Posted: 5-11-21 | Mikey Anderson

(Re)imagining gender through stories 

In my first article in this two-part series, I explored and reviewed works created by queer and trans clinicians who approached internalized transphobia from a clinical perspective, and offered actionable steps to dismantle it in the therapeutic space with clients. In this second and final installment, I explore memoirs from [...]

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Depathologizing Kink in Therapy

Posted: 4-17-21 | Rachel Gombos

Please note that this article contains content related to sexual trauma.

Surviving sexual trauma can change the way that sexual contact is experienced and enjoyed, and the prevalence of posttraumatic stress disorder symptoms in sexual assault survivors is outrageously high, at around 94% (Chivers-Wilson, 2006). At the same time, rediscovering enjoyable physical contact as a [...]

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Mono-Poly Relationships in Therapy

Posted: 4-1-21 | Stephanie Sullivan

Ask Us Anything: How does a therapist deal with a couple where one partner prefers monogamy and the other wants to be polyamorous?

 First, we can consider the many ways in which one might ask this question, which can change its meaning. There are several situations when this will come up in the therapy room, and [...]

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Decolonizing Your Practice with Trans Clients

Decolonizing Your Practice with Trans Clients:

Actions Steps and Resources

As a reminder, my goal in writing this two-part series is to reflect on the ways in which TGNB-affirming* clinicians contribute to colonization (Part 1), while also offering, in this article, actionable ways of moving toward decolonization and gender liberation.

[...]

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Misgendering a Client in Therapy

Posted: 3-4-21 | The Affirmative Couch

Ask Us Anything: How to navigate moments of rupture and repair in the therapeutic relationship when a therapist missteps re: a client’s gender identity or expression? Important to acknowledge and apologize to the client and strive to do better – other things to keep in mind if/when this happens?

Wonderful question! You are definitely on [...]

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Why LGBTQIA+-Affirmative Primary Care Matters

Posted: 2-17-21 | Madeline Hodgman

With the global COVID-19 pandemic continuing into its second year, the conversation around access to healthcare has never been more relevant. For many people, going to a doctor for an annual physical was not feasible before the pandemic, whether due to lack of insurance coverage, financial cost, taking time off from work, transportation issues, or [...]

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Affirmative Therapy: Crystal Meth in the Black Gay Community

Posted: 2-10-21 | Jerry St. Louis, LGSW

Crystal Meth & the Gay Community

Crystal meth has had a devastating effect on the gay community. Over the last 20 years, the drug–also known by its street name, Tina–has grown into a catastrophic force, contributing to about 15% of all drug death overdoses (NIDA, 2019). Because gay and bisexual men use methamphetamines at a [...]

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Therapists Facing Internalized Transphobia

Posted: 1-20-21 | Mikey Anderson

Moving Towards Trans and Nonbinary-Affirmative Therapy Practice

As psychotherapists, we know that transphobia’s pervasive social impact affects our clients and our own internal worlds. This results in transgender and gender nonbinary (TGNB) folx internalizing society’s gender-normative attitudes and lays the groundwork for them to develop negative attitudes about themselves and their communities, which can ultimately [...]

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13 Signs You Need to Decolonize Your Practice with Trans Clients

13 Signs You Need to Decolonize Your Practice with Trans Clients: 

Paying Attention to Your Colonization-Connected Behaviors

This two-part series is intended to first reflect on the ways in which transgender and gender nonbinary (TGNB)-affirming clinicians perpetuate harm connected to colonization, then to present actionable ways of moving toward decolonization and [...]

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Kink-Aware Therapy: Consent and Negotiation

Posted: 12-16-20 | Rachel Gombos

By Rachel Gombos MSW, LISW

Please note that this article contains content related to sexual trauma.

In this article, the first in a three-part series about kink-aware therapy, I will lay the groundwork for practitioners to gain an understanding of BDSM and key concepts such as consent and negotiation. Many may believe that BDSM represents [...]

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Psychotherapy with Unsupportive Parents of Transgender and Gender Nonbinary Clients

Posted: 12-9-20 | The Affirmative Couch

Ask Us Anything: How should I handle the pronouns of and name for adolescent trans clients when their parents refuse to use the correct ones? Obviously I want to support my client by using their pronouns and name, but I also feel like it is a fine line between that and making parents angry so [...]

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Why LGBTQIA+ Affirmative Therapy is Critical During the Pandemic

Posted: 11-25-20 | The Affirmative Couch

LGBTQIA+ Affirmative Mental Health During the Pandemic

The stress and anxiety wrought by the COVID-19 pandemic may be universal–so many of us face fears of the virus itself, not to mention job loss, illness striking our loved ones, and myriad missed social, professional, and financial opportunities–but all of us experience these differently. Just as everyone’s [...]

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Substance Abuse Treatment Needs to Affirm LGBTQIA+ Clients

Posted: 11-18-20 | Madeline Hodgman

“Grant me the serenity to accept the things I cannot change, the courage to change the things that I can, and the wisdom to know the difference.”

In 12-step treatment settings, the Serenity Prayer often makes an appearance at the beginning or end of a group session in substance abuse treatment. Drawn from the Christian [...]

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Helping Queer Clients Become Their Own Liberators

Posted: 9-9-20 | Matthew Spector

Liberation Psychology’s Critical Contribution

Keywords: Liberation, Psychology, LGBTQIA+, Affirmative, Queer, Decolonizing, Martin-Baro, Anti-oppression

Liberation psychology strives to understand and address the oppressive sociopolitical structures affecting communities in order to promote their healing (Martín-Baró, 1994). Developed by the Spanish-born psychologist Ignacio Martín–Baró in 1970s El Salvador, liberation psychology tasks itself with examining contexts of oppression in [...]

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How to Help Clients with Queer Impostor Syndrome

Posted: 8-19-20 | Madeline Hodgman

Keywords: queer, LGBTQ, LGBTQIA, impostor syndrome, impostor, cognitive behavioral therapy, CBT, core beliefs

I thought I identified one way, but now I’m not sure. What if this really was just a phase?

I’m afraid I won’t like all of the changes medical transition will cause to my body. What if I’m not really trans?

Can [...]

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Long-term Survivors Living with HIV: Considerations for Practice

Posted: 8-1-20 | Jill Gover, Ph.D.

In my previous article, I explored the many challenges unique to individuals who are aging with HIV. In order to overcome these, long-term survivors (LTS) need the support and expertise of competent psychotherapists. Effective treatment to reduce symptoms from this type of sustained trauma requires interventions that focus on strengthening resiliencies and creating a [...]

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A COVID-Era Review of Five Fabulous LGBTQIA+ Adult Coloring Books

Posted: 7-11-20 | Stephanie Sullivan

Coloring Books in Therapy

Coloring books aren’t just for children anymore: adult coloring books have gained great popularity in the last few years. They have been found to reduce symptoms of anxiety and depression; increase perseverance; and provide short-term stress relief (Eaton & Tieber, 2017; Flett et al., 2017; Rajendran et al., 2020; Simmons, 2016). [...]

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Long-term Survivors Living with HIV: History and Clinical Considerations

Posted: 6-23-20 | Jill Gover, Ph.D.

This year, more than 70% of people living with HIV (PLWH) in the U.S. will be ages 50 and older–up from 50% in 2015 (Anderson, 2015). The HIV epidemic has disproportionately impacted LGBTQIA+ people and people of color since its inception (Anderson, 2015). As anti-retroviral therapy (ART) continues to improve, the number of older PLWH [...]

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Maintaining Hope & Self-Compassion for LGBTQIA+ Clients During Covid-19

By now, we are all experiencing the impact of the ubiquitous trauma and stress surrounding COVID-19 in some way. What might have started with a distal awareness of the problem quickly snapped to a reality that the world will forever be changed by this virus. You might have also noticed the varying “stages of

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